Designing an artificial ecological mesocosm for the study of Cd and Pb impact on the immune system of experimental animals.

Studies on the influence of high heavy metal concentrations (Pb and Cd) on the immune status of experimental animals were carried out. The experiments were performed with Balb/c mice and Pb and Cd concentrations 30- and 50-fold above the limit admissible concentrations (LAC), respectively. A slight increase in the phagocytic activity after 5 days of treatment with high doses of the heavy metals (HM) and its significant activation on the 30th day for both concentrations were observed. Low doses of the HM cause significant increase in the spontaneous production of H2O2 on the 30th day of the experiment. The production of H2O2 by stimulation with PMA macrophages was also activated on the 30th day but to a lower degree and only with the high doses of the HM. Inhibition of the alternative pathway of complement activation was observed in animals treated with low and high doses of the HM for 90 days.

Accuracy of bimanual palpation versus vaginosonography in determination of the measurements of pelvic tumors.

In a prospective study the size of 157 pelvic tumors in 101 patients was measured preoperatively by bimanual palpation and vaginosonography, and the results were compared with measurements made at operation. In 72 uterine and 85 ovarian lesions the Spearman correlation coefficients (rs) between the three maximum diameters at right angles to each other measured at operation and by bimanual palpation ranged from 0.48 to 0.78. The correlation coefficients (rs) between measurements at operation and preoperative vaginosonography ranged from 0.91 to 0.97. The size of small lesions was overestimated by bimanual palpation; 44% of tumors smaller than 5 cm in diameter were only detected by vaginosonography.

[Opinion of mothers on continuous peridural obstetrical anesthesia]. / Beurteilung der geburtshilflichen kontinuierlichen Periduralanaesthesie durch die Mutter.

The general opinion on epidural anesthesia in obstetrics may be adversely affected by recent public controversies about the mother's situation during childbirth in hospital, which nowadays is often considered to be a highly technological, impersonal, or "unnatural" procedure. This assumption led us to conduct an inquiry on maternal assessment of obstetric epidural anesthesia and its relation to the clinical and social history. The study included 113 parturients, who received epidural anesthesia (on-demand epidural injections of bupivacaine 0.25%) for vaginal delivery. Mothers were asked to answer certain questions about this regimen (e.g. analgetic efficacy; difficulties in deciding on this method; recommendations to other parturients; opinion of the role of epidural anesthesia in obstetrics; choice of analgesic regimen for future childbirth) 1 day after delivery and 2 months later. Additional social and historical factors (e.g. education; profession; family status; preceding pregnancy, childbirth or abortion; complications during pregnancy or childbirth; duration of parturition) were used to reveal relevant statistical correlations. Sixty-five percent of the patients considered pain relief by epidural anesthesia as "good" or even "very good" during the first inquiry immediately after childbirth. Women who had undergone prior interruptions of pregnancy were less satisfied, probably because of their rather ambiguous attitude towards motherhood. With regard to the choice of analgesic regimen for future childbirth (50% of the patients had made a definite decision to have epidural anesthesia under this condition), those women were especially reserved who had suffered from complications during pregnancy and disapproved of it in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of various premedication agents, inhalation anesthetics and adjuvants on anesthesia with an opioid, alfentanyl]. / Uber den Einfluss verschiedener Prämedikationsmittel, Inhalationsanästhetika und Adjuvantia auf Narkosen mit dem Opioid Alfentanil.

Alfentanil mask anaesthesia was performed in 63 patients undergoing termination of pregnancy or curettage. Three different types of premedication were used: a) pethidine, promethazine, and atropine; b) diazepam and atropine; c) atropine. The patients were ventilated either with nitrous oxide and oxygen or with halothane and oxygen. Halothane reduced the frequency of muscular rigidity (32%; N2O 75%), postoperative sickness, and vomiting (23%; N2O 50%). On the other hand, patients regained consciousness earlier if nitrous oxide was used. Premedication a) also reduced the frequency of nausea and emesis (21%; other premedications 63%).-Alfentanil intubation anaesthesia was performed in 52 patients undergoing laparoscopy. Premedication and inhalation anaesthetic varied as described above in the group with mask anaesthesia. Muscular rigidity did not occur, and nausea/emesis were rare events (8%). Halothane prolonged the recovery phase of consciousness and respiration. Premedication a) also resulted in respiratory depression.

[Hemodynamic effects following bolus administration of different vasopressive agents for blood pressure stabilization during peridural anesthesia]. / Hämodynamische Veränderungen nach der Bolusgabe verschiedener Vasopressiva zur Blutdruckstabilisierung bei Periduralanaesthesie.

Vasopressors are often used to counteract hypotension induced by sympathetic blockade during epidural or spinal anaesthesia. This study contains data of invasive haemodynamic investigations following single-shot applications of different vasoconstrictor agents (Akrinor, etilefrine, ephedrin, norfenefrin, amezinium) during a combination of epidural block and controlled ventilation with oxygen and nitrous oxide. In a preceding dose finding study equipotent dosage of the substances used was confirmed. Usually bolus application of these vasopressors causes only a short-lasting circulatory stimulation, which does not cover the whole period of sympathetic blockade (exception: amezinium). Even small doses of drugs acting only upon alpha-receptors, may cause unwanted peripheral vasoconstriction and decrease of the already lowered cardiac output (example: norfenefrine). The rise of blood pressure after betamimetics may be delayed by an initial vascular beta 2 stimulation (example: etilefrine). In other sympathetic stimulants venoconstriction and therefore improvement of cardiac output by increase of preload takes place after an interval of some minutes to cardiac stimulation (example: ephedrin, Akrinor). Though the use of vasopressor agents during central blockade cannot be recommended in general, substances with alpha- as well as beta-stimulation should be preferred, if necessary. When using substances with short duration of action continuous infusion has to be taken into consideration.

[Hemodynamic effects in antagonism of neuromuscular blockage: atropine-pyridostigmine versus ipratropium bromide-pyridostigmine]. / Hämodynamische Wirkungen bei Antagonisierung der neuromuskulären Blockade: Atropin-Pyridostigmin versus Ipratropiumbromid-Pyridostigmin.

Antagonism of neuromuscular block using cholinesterase inhibitors and atropine is charged with several risks, which are at least partly caused by pharmacological characteristics of the anticholinergic drugs, e.g. short duration of action causing secondary bradycardia. Compared to atropine, ipratropium bromide, a new anticholinergic drug, is--due to its quarternary ammonium compound--characterized by longer duration of action. In contrast to atropine, this substance does not penetrate the blood-brain and placental barrier. Our present study was designed to compare the haemodynamic effects of both substances, using invasive monitoring, during antagonism of neuromuscular block with pyridostigmine. In contrast to atropine, ipratropium bromide induced a higher degree of initial tachycardia but did not allow secondary reduction of heart rate by rebound vagal stimulation. While cardiac output was almost constant, ipratropium bromide caused changes in stroke volume, which were due to alterations in heart rate. There were no clinically relevant changes of the other haemodynamic parameters. Cardiac arrhythmia were observed more often after administration of atropine and were of longer duration. In conclusion, ipratropium bromide is a useful alternative to atropine in patients with pre existing low heart rate and bradyarrhythmia.

[Hemodynamic and respiratory effects of tramadol during nitrous oxide-oxygen-artificial respiration and in the postoperative period]. / Hämodynamische und respiratorische Effekte von Tramadol bei Lachgas-Sauerstoff-Beatmung und in der postoperativen Phase.

The haemodynamic effects of intravenous tramadol (two different doses: 0.75 mg/kg b.w. or 1.5 mg/kg b.w.) during artificial ventilation with oxygen and nitrous oxide were investigated in 20 female patients before the start of operation. Haemodynamic changes were characterized by a moderate increase in blood pressure concerning systemic as well as pulmonary circulation. These effects were due to a rise in peripheral and pulmonary vascular resistance. Application of tramadol immediately after the end of operation (n = 20:10 patients following neuroleptanalgesia and 10 patients after anesthesia with halothane) led to a slight antagonizable decrease in respiratory frequency and respiratory amplitude as well as increase in paCO2. While during conventional pain-therapy no haemodynamic and respiratory side-effects of tramadol could be demonstrated, the typical qualities of opiates (postoperative ventilatory embarrassment) and unspecific adrenergic effects have to be taken into account after use of high doses for anaesthetic purposes.

[Somatostatin in the medical treatment of fistula of the pancreas and the small intestine]. / La somatostatine dans le traitement médical des fistules du pancréas et de l'intestin grêle.

Somatostatin is a peptide hormone which inhibits the secretion of the growth hormone and certain gastrointestinal hormones. Its main effect is to reduce the gastric acid output and inhibit the exocrine function of the pancreas. It was therefore used as an adjuvant therapy in the conservative treatment of ten patients presenting with fistulas of the small intestine or pancreas. The treatment was successful in eight cases. The short halflife of the hormone makes continuous application of the somatostatin as important as the carrying on of the conservative treatment itself.

[Influence of different preinjections on unfavourable side-effects of succinylcholine-induced block (author's transl)]. / Einfluss unterschiedlicher Vorinjektionen auf unerwünschte Begleiterscheinungen des Succinylcholinblocks.

Pretreatment with a subparalytic dose of a nondepolarizing relaxant is used to prevent side-effects of the succinylcholine (Sch) dose needed for intubation. On the other hand small doses of Sch (self-taming) or lignocaine are recommended to avoid in part reversal of the Sch-induced block caused by nondepolarizing relaxant. 50 patients received different preinjections before Sch-induced relaxation: 2 mg alcuronium, n = 10; 1 mg pancuronium, n = 10; 0.1 mg/kg bw Sch, n = 10; 1 mg/kg bw lignocaine, n = 10; no pretreatment, n = 10. Injection of small doses of Sch or lignocaine prior to the Sch dose needed for intubation, offered no advantage in comparison to the conventional method of pretreatment with nondepolarizing relaxant, concerning intensity and duration of the relaxation, conditions for intubation and muscle fasciculations. After preinjection of Sch or lignocaine a similar rise of serum potassium was observed as without preinjection (0.4-0.5 mEq/l).

[Epidural application of opiates in chronic pain due to malignoma (author's transl)]. / Peridurale Opiatapplikation bei malignombedingten chronischen Schmerzen.

In 75 patients epidural opiates were applied for relief of chronic cancer pain. In order to avoid local infection during long-term therapy part of the catheter was placed subcutaneously. Different opiates were used separately or in combination with local anaesthetics to define the degree and duration of pain relief after epidural opiate application. Haemodynamic and respiratory parameters, changes in lower extremity blood supply and other side-effects were recorded during epidural pain therapy. Epidural opiate application cause a long-lasting reduction of pain, which may become restricted during long-term or repeated use, especially after a period of systemic opiate therapy. Side-effects, for example slight respiratory depression in the first hour after injection, indicate an initial phase of resorption beeing followed by a long-lasting reduction of pain without attendant symptoms. Keeping in mind certain precautions epidural opiate therapy is superior to systemic opiate application.

[Epidural morphine as adjunct to epidural anaesthesia in obstetrics (author's transl)]. / Peridurales Morphin als Adjuvans der geburtshilflichen Periduralanaesthesie.

Epidural opiate as a single analgesic during labour failed to relieve pain sufficiently. According to a synergistic effect of epidural opiate and local anaesthetic a combination of both drugs appears to be useful for obstetric analgesia. In a double-blind-study a single epidural morphine-application at an early stage of labour led to prolonged intervals of reinjection during conventional epidural anaesthesia with bupivacaine. The reduced dosage of local anaesthetic improves neonatal status and reduces the necessity of extractional aids. In addition the long-lasting postpartum pains. Side-effects, such as vomiting and pruritus, are rare.

[Preparation for anesthesia and surgery of the aged patient with circulatory disease (author's transl)]. / Präoperative vorbereitung alter Patienten mit kardiovaskulären Erkrankungen aus anästhesiologischer Sicht.

Higher life-expectancy and progresses in operative medicine and anaesthesiology increasingly confront the anaesthesist with the necessity of performing anaesthesia in elderly patients. The most frequent disease in this group of patients are related to the cardiovascular system (hypertension, coronary heart disease, arrhythmia and myocardial insufficiency. Preoperative cardiovascular therapy with regard to anaesthesia is outlined.

[Haemodynamic effects and characteristics of midazolam during induction of anesthesia (author's transl)]. / Hämodynamische Wirkungen und Charakteristika der Narkoseeinleitung mit Midazolam.

Our investigations have shown the following: 1. 8-Chloro-6-(2-fluorophenyl)-1-methyl-4H-imidazo[1,5-a] [1,4]benzodiazepine (midazolam, Ro 21-3981, Dormicum) produces no adverse haemodynamic changes in healthy subjects. 2. The reduction in peripheral resistance becomes apparent mainly in the case of raised baseline values, as, for example, in hypertensive subjects, but it can also be of significance prior to anaesthesia, when there may be raised systemic vascular resistance due to stress. 3. Venous pooling, which leads to a decrease in pre-load and subsequent lowering of the cardiac index, can have a compensatory effect in cardiac insufficiency. Under certain conditions, as for example, in the case of imminent volume deficit, a marked fall in pressure is to be expected. 4. The haemodynamic effects of midazolam are thus limited to vascular reactions. Under certain circumstances volume therapy may be necessary before the drug is used.

[Epidural opiates for relief of chronic pain (author's transl)]. / Traitement des douleurs chroniques. Utilisation des morphiniques par la voie péridurale.

Epidural opiate application was performed in 75 patients with chronic pain due to abdominal cancer. To reduce the risk of local infection, the epidural catheter was in part placed subcutaneously. Degree and duration of analgesia were determined after epidural morphine (with and without bupivacaine), pethidine or fentanyl. Hemodynamic and respiratory parameters were measured and side-effects were registered. The longest duration of analgesia was observed after epidural morphine. In long-term treatment there was a reduced efficiency and the frequency of daily injections increased, especially in those patients who already had received systemic opiates prior to the epidural opiate administration. This may be due to tolerance of the spinal receptors. A combination of epidural morphine with small doses of local anesthetics caused prolonged action and delayed the onset of tolerance. Besides slight influences on respiratory function, which may be referred to the initial period of systemic absorption, there were no relevant side-effects. Regarding certain precautions the epidural application of morphine may have advantages in comparison to systemic analgetics in treatment of chronic pain.

[Value of morphine derivatives administered by the peridural route per- and postoperatively]. / L'intérêt des dérivés morphiniques par voie péridurale en per et post-opératoire.

The existence of opiate receptors in the spinal cord led the authors to seek a clinical application. 1 - A peroperative injection of morphine was administered in 170 cases: 0.005 mg/kg of fentanyl in 105 cases and 0.05 mg/kg of morphine in 65 cases. In addition to usual surveillance (blood pressure, heart rate and central venous pressure), more extensive haemodynamic investigations were undertaken in 20 patients using a Swan-Ganz catheter. Blood concentrations (11 cases) and CSF concentrations (2 cases for each time of measurement) were determined in the case of fentanyl. In 20 patients (10 of whom had received fentanyl and 10 morphine) there was sophisticated cardio-respiratory surveillance postoperatively. 2 - 0.05 mg/kg or morphine (404 cases), 50 mg of pethidine (10 cases) and 0.1 mg of fentanyl (10 cases) were injected postoperatively. A comparison was made of the analgesia obtained. After three types of anaesthesia: epidural with bupivacaine with intubation (10 cases), halothane with intubation (10 cases) and neuroleptanaesthesia (10 cases), an injection was given of 0.05 mg/kg of morphine, with cardiorespiratory surveillance. Results were as follows: 1 - There were no significant variations in haemodynamic parameters peroperatively, indicative of adequate analgesia. Blood concentrations of fentanyl were as follows: 3.2 +/- 2.1 ng/ml after 10 minutes, 2 +/- 1.7 ng/ml after one hour, 1.4 +/- 1 ng/ml after two hours and 0.4 +/- 0.3 ng/ml after four hours. CSF concentrations were much higher; 34 ng/ml after one hour, 30 ng/ml after two and three hours and 25 ng/ml after four hours. No cardio-respiratory depression was seen after the peroperative injection of morphine. 2- The duration of analgesia following a postoperative injection of a morphine derivative was as follows: morphine 17.3 +/- 3.9 hours, pethidine 3.5 +/- 0.5 hours, and fentanyl 5.1 +/- 0.7 hours. The epidural injection of morphine after neuroleptoanaesthesia caused respiratory depression in two of the 10 cases, with a rise in pCO2 of 0.45 and 0.52 KPa. The results are discussed and compared with those of other authors. In conclusion, the authors emphasize the advantages of this method which makes it possible to obtain with smaller doses analgesia of longer duration than following a systemic injection of morphine, whilst at the same time decreasing the side effects.

[Intraoperative peridural opiate analgesia (author's transl)]. / Intraoperative peridurale Opiatanalgesie.

Epidural injection of small doses of opiates causes a reduction of pain in the lower parts of the body. The use of epidural opiate-analgesia for surgical anesthesia, combined with controlled ventilation (oxygen-nitrous oxide), was investigated in 170 patients undergoing surgery, especially long lasting gynaecological operations. Haemodynamic monitoring demonstrated a constant cardiovascular situation, underlining the sufficiency of analgesia. Blood gas analyses for one hour after the operation revealed no signs of respiratory depression. The epidural opiate-analgesia outlasted the intraoperative period, covering even the postoperative phase.